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PerspectiveBased on Science, Built on Trust
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Prairie Doc Perspective for the Week of December 8th, 2024
“Anatomical Variations: Connecting Research & Patient Care” By Ethan Snow, PhD The human body is composed of a typical pattern of anatomy, yet every structure varies in form from person to person. For example, humans develop with a standard set of defined muscles, yet the shape and mass of each muscle varies significantly among individuals. Sometimes, “anatomical variations” develop – that is, anatomical structures that do not conform to the typical range of regular morphology (for example, an entirely separate “extra” muscle that develops in one person). Human anatomy is so intricate that the prevalence of an anatomical variation is thought to be certain in every individual; in this regard, what makes each of us unique is the very thing we have in common. Certain variations can elicit complex symptoms, muddle diagnoses, and complicate treatments. Fortunately, though, most anatomical variations are asymptomatic and pose little to no clinical concern. Sometimes variations can even be beneficial; for example, an accessory muscle-tendon unit can be useful autograft material in musculoskeletal reconstruction surgeries. Anatomical variations are challenging to study because they are often found incidentally. In surgery, clinicians operate in a limited window of visibility in order to complete procedures with minimal incisions. When surgeons find an unexpected variation in their operating window, they often only see part of it and are not able to expose the entire structure. Anatomists, however, dissect the entire body (as an embalmed cadaver) and expose variations in full detail. Cadaveric case analyses of anatomical variations provide clinicians with insights for adjusting protocols to suit variations during surgery and in noninvasive treatment plans, and they help anatomists teach clinically significant variations to students learning human anatomy. Strategic anatomist-clinician collaborations foster the mutual exchange of expert-level skills to promote the highest-quality medical education and patient care, particularly involving anatomical variations. These collaborative relationships form the fundamental underpinning of evidenced-based medicine and embrace the “bench-to-bedside” model for making translational research influential to patient care. Modern technology has improved the study of anatomical variations. Many anatomical case analyses now involve radiologic imaging, histopathology, digital modeling, and other contemporary techniques, making them more relevant to clinicians and patient care. In the fast-paced disciplines of education and medicine, innovations such as virtual reality (VR) are being used to advance anatomy education and improve patient care. While defined variations and clinical conditions can be simulated by technology and offer many impactful benefits, tech-based programs are currently unable to generate accurate models of potential anatomical variations. For the nearly 2500 years, human cadavers from whole body donors have served instrumental roles in establishing anatomical knowledge, including what is known about anatomical variations. Human cadavers are unparalleled for tactile feedback, unscripted anatomical variations, and clinical associations. They also convey more than anatomy; they are considered by most students as their first patients and teach students about clinical anatomy, variation, disease, ethics, humanity, respect, and many other important values. Educators, clinicians, and students remain extremely grateful to whole body donors for their selfless contributions to advancing medical education, knowledge, practice, and patient care – particularly as related to anatomical variations. Ethan Snow, PhD is an Anatomist and currently serves as an Assistant Professor of Innovation in Anatomy at South Dakota State University in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. Prairie Doc Perspective Week of December 1st, 2024
“Doctor Chekhov, Physician & Writer” By: Eric Holm Literature classes worldwide study Anton Chekhov (1860-1904), a great innovator of the short story. He wrote closely observed and deeply empathic slices-of-life with a great sense of humor — but the Russian-Lit-class-version of Dr. Chekhov often overlooks the vitality of his work in the theater. Theater-people like me know him as a playwright, the creative counterpart to the acting teacher Konstantin Stanislavsky, who directed and starred in Chekhov's breakthrough play, The Seagull. Together with the other artists of Moscow Art Theater, Chekhov and Stanislavsky pioneered a new style of ensemble performance, focusing on the whole society, rather than one "main character." So if the literature-people under-appreciate his brilliance as a playwright, and theater-people undervalue his excellence in prose, both groups could stand to note his life-long dedication to medicine. Even after he became a famous writer, Dr. Chekhov never stopped seeing patients, and at the height of his literary career, he traveled nearly 6000 miles from Moscow to a notorious prison on Sakhalin Island to study the failures of the island-prison’s health care system. After his trip, Chekhov wrote a carefully reported book-length argument for prison health care reform, a work of investigative medical journalism. He once wrote in a letter: “Medicine is my lawful wife, and literature is my mistress.” My Dad was the great Dr. Rick Holm, whose mind was also rich with a multiplicity of passions and talents. I sometimes think that the way Chekhov’s devotion to medicine was overshadowed by his success as an artist is an inversion of the way my Dad’s devotion to art was overshadowed by his success as a doctor. He was well-known as a singer and a choral conductor, founding the (still ongoing) Hopeful Spirit Chorale, but his other artistic pursuits were less well-known: he was a fine amateur painter, a long-time member of the board of Prairie Repertory Theater, a talented draftsman (his book Life’s Final Season includes his own anatomical drawings), and when he died, he was writing historical fiction — a novella set in in the twelfth century in Salerno, Italy, about the first Western medical school. I think Dr. Chekhov's perspective as a physician sharpened his observational powers as an artist. His plays and stories are full of people who suffer from habits of mind that they can’t understand; the good doctor seems, with his careful, diagnostic observation, to identify problems with his characters’ mental health (obsessions, depressions, manias, addictions) years before the vocabulary for such mental health disorders had been developed. Like Shakespeare, Dr. Chekhov writes honestly about both the very poor and the very rich, treating servant characters with as much detail and dignity as the owners of the estate. Though the good doctor’s ‘slice-of-life’ literary style is deeply rooted in reality, his work is paradoxical, both traditional and unconventional at once, using a physician’s skill-set and a prescient fascination with the health-of-the-mind to create literary, theatrical, and journalistic work that was, thrillingly, ahead of its time. Eric Holm is an artist and teacher working mostly in performance, film, and music. He trained in Minneapolis and New York and is a founding member (with fellow Brookings-person Katie Melby) of the BREAD Arts Collective. Now based in Houston, Texas, Eric is an adjunct theater and film professor at the University of Houston, Galveston College, and Lone Star College, and is working on self-producing his second album. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. Prairie Doc Perspective Week of November 24th, 2024
“Giving Thanks” By Joanie Holm, CNP Would you like to sleep better, have a healthier heart and less aches and pains? How about a lower blood pressure, a higher self -esteem and enhanced relationships? Would you believe that the Mayo Clinic and Harvard University, as well as other scientist all say these benefits can be yours with very little effort. And it doesn’t require a change in your diet or excessive exercise! So, what is this magical therapy? GRATITUDE!! Gratitude comes from the Latin word gratia, which means grace, graciousness or gratefulness. Psychologist’s Robert Emmons of University of California, Davis and Michael McCullough, University of Miami, were early researchers in this field. They found that 10 weeks of practicing gratitude can result in the outcomes listed above as well as: an increased happiness score, increased optimism, increased exercise, decreased physician visits, increased focus, increased patience and strengthened social connections. Wow, who doesn’t want these health and relationship benefits? Gratitude is like a muscle that you can build with exercise and practice. There are many ways to increase your gratitude muscle such as writing thank you notes, saying thank you to others in person or just mentally, writing a gratitude journal, praying and meditating. Other experts mention benefits from a brief, positive chat with a friend, a kind gesture toward a stranger and a peaceful stroll in nature. A change in mindset can help you feel better, for example feeling grateful for a helpful friend rather than feeling frustrated that you can do the task alone. Lets get started on this journey of gratitude. Thank you for reading this essay and for watching On Call with the Prairie Doc. Thanks to all of my friends and family for the love and support you give me daily. Thanks to my church family for your spiritual support. Now it is your turn…. Joanie Holm, CNP is the Prairie Doc Board President and co-founder of Prairie Doc Programming. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm streaming on Facebook), 2 podcasts, and a Radio program, providing health information based on science, built on trust. Prairie Doc® Perspectives for week of November 24th, 2024
Caring for Expectant Moms By Debra Johnston, M.D. Lately my teenager has been fascinated by medical dramas. Although my “doctor self” is usually rolling my eyes throughout the program, it’s often a good conversation starter. One recent show featured a pregnant woman who experienced one medical crisis after another. Her kidneys, liver, and lungs failed in succession as the team raced to identify the underlying obstetrical problem and find a treatment. At the climax of the episode, her heart stopped. Of course, being television, the correct diagnosis was made, the experimental treatment worked, and the episode ended with a perfectly healthy mother at home, holding her perfectly healthy baby. For all the erroneous and outrageous details that transform bad fictional medicine into good TV, they did get something right. Pregnancy is a dangerous condition. In fact, in America, pregnancy complications account for approximately two percent of all deaths among women between the ages of 20 and 44. To put the two percent into perspective, consider that pregnancy complications can only happen in the months during and immediately following pregnancy. On average a woman in the United States will birth between one and two children. This means that between the ages of 20 and 44, the risk of pregnancy-related death isn’t spread across those 25 years as are the risks of cancer or car accidents. It is concentrated into the relatively few months during which she is pregnant. And for women younger than 20 and older than 44 the risk of pregnancy complications is even greater but, statistically speaking, women in those age groups simply don’t have enough babies to categorize pregnancy complications as a major cause of death. Consider also that death by violence is not counted as a pregnancy complication, even though pregnancy is a significant trigger for violence. What’s more, consider that these risks are not distributed equally between women. Socioeconomic status, education, physical location, and race all impact the likelihood of pregnancy complications, and death from those complications. Issues that affect pregnant people affect their whole family. In medical school, I was taught “nothing is worse for a fetus than a dead mother.” It’s hard to disagree. So, what can we do to make pregnancy safer? The answer to that question is multi-faceted. Access to quality obstetric care is one factor. However, we must also ensure women are as healthy as possible before they conceive. They need good nutrition and safe places to live and work. They need education to know what is normal, and what is not. They and their families need access to psychiatric care to address mental illness and addiction. It may not make for good TV, but in the real world, the starting place is as basic, and as difficult, as that. Debra Johnston, MD. is part of The Prairie Doc® team of physicians and currently practices as a Family Medicine Doctor at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. Prairie Doc Perspective Week of November 10th, 2024
“Protecting Children from Online Harms” By Christina Young, Director for the Center for the Prevention of Child Maltreatment With the rapid rise in internet use among children, the dangers of online exploitation have grown alarmingly. Children’s access to the internet has become nearly ubiquitous, especially following the COVID-19 pandemic. Remote learning, online gaming, and social media are now integral to daily life, meaning more children, even preschool-age children, are regularly online, often unsupervised and unprotected. This new reality demands that we consider not only physical safety for our children, but also the dangers they are facing online. The Scope of the Issue In 2022, the National Center for Missing & Exploited Children received almost 32 million reports of suspected child sexual abuse materials (CSAM), representing 88.3 million files. In 2023, more than 100 million such files were reported. There has also been an increase in “self-generated” content (children taking pictures of themselves and sharing it with others online), involving children as young as seven, shows how manipulation and grooming by online predators are impacting younger children. Another concern is how easily children can access harmful content—often unintentionally. One study found that 15% of children encounter pornographic material before age 10, often due to algorithms or suggested content. This early exposure to harmful content can initiate a cycle of curiosity and risky behavior online. Over time, children can become desensitized and seek more extreme material, a phenomenon known as "content escalation." This can distort their understanding of healthy relationships and boundaries which could lead to long-term psychological and social risks that complicate their ability to form safe, meaningful connections. Understanding Risk Factors Every time a child accesses the internet, they face potential risks. Children with low self-esteem, developmental challenges, or mental health struggles are particularly vulnerable to manipulation. Sensation-seeking behaviors and inadequate supervision heighten this risk, as children venture into digital spaces that leave them exposed to harm. How Technology Compounds the Problem Artificial intelligence (AI) and social media are significant drivers of online exploitation. AI enables the creation of “deep fakes,” complicating victim identification and creating new avenues for child exploitation. Meanwhile, social media algorithms frequently push harmful content to young users, and data privacy concerns remain largely unaddressed. Platforms designed for engagement can lead to addictive behaviors, making children even more vulnerable. The Path Forward: What We Can Do We have a shared responsibility to protect children. Here are essential steps we can take:
For more information on protecting children from online harms, visit the South Dakota Center for the Prevention of Child Maltreatment’s website. Together, we can make a difference. Christina Young has been an influential figure in the child welfare field for over a decade, dedicating her career to the well-being of children and families. She directed an in-home family services program covering 30 western counties in Iowa, demonstrating her commitment to community-based support. Christina has also served with a Single-Family Office and as COO of a mid-sized, midwestern law firm. Christina has a bachelor’s degree in psychology and a master’s in human services administration. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. Prairie Doc Perspective Week of November 3rd, 2024
“Listen up and keep your hearing” By Andrew Ellsworth, MD Hearing loss affects millions of Americans. In fact, by age 75 over half of adults will have some form of hearing loss. Signs of hearing loss include having trouble hearing speech in noisy places, finding it hard to follow speech in groups, trouble hearing on the phone, listening makes you tired, or if you need to turn the volume up on the TV or radio while others complain it is too loud. To some, hearing loss may just be a minor inconvenience. If it is more severe, however, it can have a big impact on day to day activities, impairing communication, safe driving, safe walking, and has even been shown to increase rates of depression and dementia. When people disengage from others because they cannot hear well enough, people may become more withdrawn, and might not enjoy many of the things they used to. The simplest solution is to try hearing aids. While hearing aids are available over the counter, they are recommended only for adults with mild to moderate hearing loss. Meanwhile, it may be a good idea to see an audiologist or an Ear, Nose, and Throat (ENT) physician for a thorough assessment first. Warning signs you should seek medical care include seeing blood, pus, or fluid coming out of your ear, ear pain, an ear deformity, feeling something is in your ear, dizziness or vertigo, sudden changes or variations in hearing, worse hearing in one ear, or ringing or buzzing (tinnitus) especially if it is in only one ear. At least one quarter of hearing loss is due to prolonged exposure to loud noises, and even brief exposure to very loud noises like gunfire can cause hearing loss. Loud concerts, sporting events, car stereos, machinery, occupational exposures, and more all play a role. In addition, because of ear buds with the volume turned up, even going on a walk on a peaceful bike path can contribute to hearing loss. Besides loud noises, other causes of hearing loss include ear infections, genetic factors, infections during fetal development, trauma, medications, smoking, chronic diseases, and more. Ear wax can cause temporary hearing loss. However, be careful how you remove it to avoid causing damage to the tympanic membrane. In other words, it’s best to avoid sticking anything in your ear. In addition to hearing aids and other hearing assisted devices, cochlear implants have been revolutionary in treating hearing loss. Instead of amplifying sound, cochlear implants help by bypassing damaged portions of the ear and directly stimulating the auditory nerve. This has been a life-changing method at helping people of all ages to hear, even infants as young as 9 months of age. If you ever need a pick-me-up, search online for videos of infants and kids hearing for the first time with a cochlear implant. Andrew Ellsworth, MD. is part of The Prairie Doc® team of physicians and currently practices Family Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. Prairie Doc Perspective Week of October 27th, 2024
“HPV causes cancer, and can be prevented” By Andrew Ellsworth, MD What do warts, pap smears, cervical cancer, head and neck cancer, and a vaccine all have in common? Three letters: HPV Human papillomavirus ( HPV) is a common virus that can cause growths on skin and mucous membranes. There are over one hundred different types of HPV, and while some cause common warts, others can cause cancer. HPV may be spread by skin to skin contact. The virus can enter your body through even the smallest tear in your skin. Warts caused by HPV can be contagious, either through direct contact with a wart or when someone touches something already touched by a wart. Genital or oral HPV infections can spread through sexual contact or through skin to skin contact in the genital region, anus, mouth, or back of the throat. Unfortunately it can be difficult to prevent HPV infections that cause common warts. It is helpful to avoid picking at a wart to avoid spreading it. Plantar warts located on the bottom of your feet can be prevented by wearing shoes or sandals in public pools and locker rooms. The treatment of common warts can be difficult as well. Some warts go away on their own, while others may grow despite attempts at treatment. No treatment is perfect. Persistence, however, is a key for success. Whether you treat a wart with an over-the-counter method such as salicylic acid, or go to the doctor to have it frozen, be prepared to treat the wart several times in consecutive months for full resolution. Genital warts can be prevented by abstinence, and limited by being in a mutually monogamous relationship, limiting your sexual partners, and using a condom, which can form a barrier for HPV and other sexually transmitted diseases. Thankfully, there is a vaccine which is very effective at decreasing the risk of cancers caused by HPV such as cervical cancer and some cancers in the mouth and back of the throat. It can also decrease the risk of genital warts and genital cancers. The HPV vaccine is recommended for girls and boys often at ages 11 or 12 and can be given as early as age 9 and up to age 45. It is most effective before exposure to HPV. The immune response is better at a younger age, so when given before age 15, only two shots are recommended in the series, while three shots are recommended if started after age 15. For decades, women have undergone pap smears to help catch cervical cancer in the early stages for better detection and treatment. The HPV vaccine can prevent the underlying cause of cervical cancer, can decrease the need for pap smears, and has been effective in decreasing rates of cervical cancer. Once one of the most common causes of death for American women, cervical cancer death rates were cut in half starting in the mid 1970’s with better detection and screening from pap smears. Now, a recent study in Scotland detected ZERO cases of cervical cancer in women born between 1988-1996 who were fully vaccinated against HPV before age 14. This highlights the effectiveness and benefit of the HPV vaccine. Andrew Ellsworth, MD. is part of The Prairie Doc® team of physicians and currently practices Family Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. Prairie Doc Perspective Week of October 20th, 2024
“Diabetes” By Kelly Evans-Hullinger, MD FACP The saying goes, “newer isn’t always better,” and while I typically tend to agree with that, newer might be better when it comes to glucose monitoring technology. In recent years we have seen rapid development and uptake of new types of glucometers, leaving fewer and fewer patients with diabetes using the old standby fingerstick method of blood sugar monitoring. Let me be clear: not every patient with diabetes needs a fancy new continuous glucometer (CGM). The cost might be higher, and there is certainly more data to sort through with a continuous glucometer. So who stands to benefit the most? The most compelling reason to upgrade to a CGM would be a tendency to get low blood sugars (hypoglycemia), especially if that patient does not get any symptoms or awareness of that. Hypoglycemia can be very dangerous, causing loss of consciousness, seizures, and coma. A CGM can detect a pattern of dropping sugar levels and alarm to a patient’s (or their loved one’s) device as a signal to preempt a possibly dangerous episode of low blood sugar. Patients at highest risk of this are those on insulin, elderly patients, and those with more complicated or challenging diabetes. Other reasons for patients to pursue a CGM might vary. Often in patients with poorly controlled diabetes, the data collected by a CGM can aid decision making on changes to medication, diet, and exercise at the right times of day. Some patients just truly hate pricking their fingertips, and using a CGM gives them information they can’t otherwise obtain if avoiding fingersticks. I can think of numerous patients in my own practice whose diabetes was poorly controlled, started using a CGM, then returned to clinic with major improvement in their control as manifested by their hemoglobin A1c lab, even without any changes to their medications. I attribute this to the unavoidable real time feedback a CGM gives, which probably motivates patients to change behavior in diet and exercise in ways that are hard to achieve otherwise. Continuous glucometers aren’t for everyone; some patients have excellent control of their diabetes and no hypoglycemia without this technology, in which case it probably isn’t necessary. In patients who do pursue their use, it is important to work with a clinician who can help interpret the data the CGM provides and adjust treatment accordingly. In short, talk to your endocrinologist or primary care provider if you think a CGM might be for you. Kelly Evans-Hullinger, MD. is part of The Prairie Doc® team of physicians and currently practices Internal Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. Prairie Doc Perspective Week of October 13th, 2024
“Sometimes Your Hip Pain isn’t Your Hip” By Andrew Ellsworth, MD “Doc, my right hip has been bothering me. Do you think I need a new hip?” “First, tell me more about your hip pain.” Hip pain is a common complaint which can have a variety of causes. The first thing that comes to mind is arthritis of the hip joint. The hip is a ball and socket joint. The main upper leg bone, the femur, has a rounded top called the head. Under the head of the femur is the neck, which can often be what breaks when someone suffers a hip fracture. Arthritis and wear and tear over time can cause the cartilage in the ball and socket joint to break down and become thinner and irregular. This can cause pain especially with movement and walking. A simple x-ray of the hip can help show signs of arthritis of the hip joint. Sometimes one can try physical therapy, non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, or perhaps a steroid injection to help calm down the inflammation and pain. Over time, if those efforts do not help enough or if the arthritis is advanced enough, sometimes a hip replacement may be beneficial. However, when someone reports hip pain, it may not actually be their hip joint that is the problem. Arthritis of the low back, degenerative disc disease, sciatic nerve pain, lumbar stenosis, and other problems with the back can cause pain that feels like it is in the hip. Sometimes that pain is felt deep in the buttocks. Sometimes arthritis or inflammation of the sacroiliac joint, where the low back connects to the pelvis, can cause pain. This may often be felt as low back pain, but can present as hip pain. Another cause of hip pain is bursitis or inflammation of the bursa sac located on the greater trochanter of the hip, the large upper outside edge of the femur where the neck connects to the shaft of the femur. You may be able to feel this hard area of your hip at your side. This is a common area for pain. While this pain is located at the hip, it is not coming from the hip joint. Our body has bursa sacs near bones in many places, essentially fluid-filled pads that can help protect the nearby bone and tendons and reduce friction between tissues of the body. Greater trochanteric bursitis can result from a fall, repetitive motion, weakness of muscles, or be associated with some diseases. Usually rest, NSAIDs, time, and physical therapy can help it to improve. Exercises can help by strengthening the surrounding muscles which can decrease the rubbing and friction over the bursa sac. A steroid injection can often be helpful. Surgery is rarely needed. Other causes of hip pain can be from a pelvic bone fracture, tendinopathy, a muscle strain, a labral tear, other musculoskeletal problems, constipation, infection, and rarely cancer. Thus, if you are suffering from hip pain, it may be time to see your medical provider, and start figuring out whether your hip is really the problem. Andrew Ellsworth, MD. is part of The Prairie Doc® team of physicians and currently practices family medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. Prairie Doc Perspective Week of October 6th, 2024
“Prairie Doc or Prairie Bot?” By Jill Kruse, DO Artificial Intelligence or A.I. has gone from Science Fiction to a reality. This technology continues to evolve and find new applications in the world, including the world of medicine. With any new advancement, there are pros and cons to be considered when implementing it into regular use, especially in medicine. In 2023 the Journal of Medical Internet Research published an article where they had ChatGPT take 2 of the 3 USMLE exams. Step 1 is taken by third year medical students and all physicians must pass all three tests in order to become licensed as a physician. The program was given 4 different practice tests and scored between 44 to 64.4% correct. Over 60% is considered a passing score. The headlines read that ChatGPT passes medical boards. While this headline was shocking, reading the article gives more nuances to that declaration. There were three different AI programs used, and only one had a passing score for one of the four sample tests, the easiest step 1. When the exams themselves were broken down, the AI was able to answer the “easy” questions with the greatest accuracy. Questions were graded on a score from 1 (easy) to 5 (difficult). However, it was unable to answer any of the level 5 questions. When the program was given a “hint”, the performance increased to 22% correct of the level 5 questions. Students taking the test do not get hints. For this article I decided to ask Chat GPT to list “5 ways AI will improve the practice of medicine in the next 5 years” and “5 ways AI may harm the practice of medicine in the next 5 years.” Here is what the program came up with. Here are the 5 ways ChatGPT thought AI could improve the practice of medicine
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices as a hospitalist in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook, Instagram, and Threads featuring On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust for 23 Seasons. Prairie Doc Perspective Week of September 29th, 2024
“Children’s Dental Health: Key Points for Parents” By John Bisson, DDS Good dental health in children is crucial for overall well-being. Healthy teeth enable proper chewing, speech development, and contribute to self-esteem. Prioritizing dental health through education, preventive care, and regular check-ups lays the foundation for a lifetime of healthy smiles. The following topics are common discussion points of children’s dental health. First Dental Visit Children should visit the dentist by their first birthday or within six months after their first tooth erupts. Early visits help establish a dental home and allow the dental care team to monitor oral development and provide guidance on proper care. Regular dental visits every six months are essential for monitoring dental health and catching potential issues early. Fluoride Treatments Fluoride is a naturally occurring mineral that helps prevent tooth decay. Fluoride treatments can help strengthen tooth enamel, making it more resistant to acids produced by bacteria in the mouth. This in turn helps to significantly reduce the risk of cavities and promote stronger, healthier teeth. Dentists often recommend fluoride treatments for children and may also suggest fluoride toothpaste for at home use. Dental Sealants Dental sealants are thin coatings applied to the chewing surfaces of molars (back teeth) to protect them from cavities. Sealants act as a barrier against food particles and bacteria. They are typically recommended for children once their permanent molars emerge, usually around age six. Visiting An Orthodontist Children should have their first evaluation with an orthodontist by age seven. At this age, an orthodontist can identify potential issues with tooth alignment and bite. Early intervention may prevent more severe problems later and can help guide the growth of the jaw. Thumb Sucking Thumb sucking is common in infants and toddlers and usually doesn’t cause issues if stopped by age four. Prolonged thumb sucking can lead to dental problems, such as misalignment of teeth or changes in the roof of the mouth. If a child continues thumb sucking beyond this age, parents should consult a dentist for advice. Baby Bottle Tooth Decay Baby bottle tooth decay occurs when sugary liquids like milk or juice cling to a child’s teeth, leading to decay. To prevent this, avoid putting a baby to bed with a bottle and ensure regular cleaning of the child’s teeth and gums. Water can be used as a nighttime beverage. Teeth Grinding (Bruxism) Teeth grinding, or bruxism, is common in children, especially during sleep. It can be caused by stress, misaligned teeth, or other factors. If grinding is frequent, it can wear down teeth and lead to discomfort. Parents should discuss the issue with their child’s dentist, who may recommend monitoring, relaxation techniques, or In some cases, a custom mouth guard. Dental Anxiety Dental anxiety is a common issue among children, characterized by fear or apprehension about visiting the dentist. This anxiety can stem from various factors, including fear of pain, unfamiliar environments, or negative past experiences. Prepare children by discussing what to expect at their visit, using positive reinforcement, and visiting the office beforehand to familiarize them with the environment. Regular dental checkups and good oral hygiene practices are vital for children’s dental health. Parents and caretakers should stay informed about common issues and consult their dentist for personalized advice to ensure the health of their child’s smile. John Bisson, DDS is a dentist and owns Bisson Dental in Brookings, SD. Dr. Bisson is originally from Sturgis, SD but moved to Brookings in 2015 and opened Bisson Dental in 2018. For more information about Bisson Dental head here, https://www.bisson-dental.com/. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central. Prairie Doc Perspective Week of September 22nd, 2024
“Menopause” By: Kelly Evans Hullinger MD Menopause is one of those things that, let’s face it, will ultimately affect everyone with previously functional ovaries. Unfortunately we don’t talk about it enough, which makes it a topic riddled with misinformation. So… what is menopause? Menopause is defined by the permanent cessation of menstrual bleeding for 12 months. This occurs naturally when the ovaries stop reproductive activity and a marked decrease in ovarian hormones (estrogen and progesterone) occurs. Symptoms of menopause are a result of these hormonal changes. Most women enter menopause “naturally,” or just due to aging. The average age of menopause in North America is 51 years, but that can vary by up to 8-10 years on either side. However, menopause can also occur when the ovaries are surgically removed or if a patient needs to take a medication that affects ovarian hormone secretion, for example certain therapies for breast cancer. Perimenopause refers to the phase, often lasting 1-2 years, before complete cessation of menses in which a person is likely to experience irregularities in menstrual periods (shorter or longer intervals, lighter or heavier bleeding) and sometimes the start of menopausal symptoms like hot flushes. Some patients will experience problematic or heavy perimenopausal bleeding that warrants medical or surgical treatment. It is worth noting that laboratory testing is not recommended to diagnose menopause in a patient of typical age range with expected menopausal symptoms. In some cases, especially if a patient is younger than expected, limited testing is warranted to rule out other conditions including pregnancy and thyroid disorders. Some fortunate women experience no significant symptoms of menopause, but the majority will. The most common symptoms of menopause are the infamous vasomotor symptoms (hot flashes and night sweats) and urogenital symptoms (vaginal dryness and sexual dysfunction). The average duration of vasomotor symptoms after menopause is about 7 years, but approximately 10% of women have symptoms lasting more than 10 years. Decisions around various options for treatment for these symptoms is highly individualized and depends on how symptoms are affecting a given patient’s quality of life. Treatment, if warranted, can involve hormonal therapy (replacing estrogen is the most effective way to reduce hot flashes) or various non-hormonal options. This choice necessitates a conversation about an individual’s symptom severity and that patient’s risk of hormonal therapy, including breast cancer, blood clots, and cardiovascular events. In summary, menopause is indeed a part of life. However, if you are really suffering with symptoms of menopause, it is worthwhile to talk to your healthcare provider about potential treatment for your symptoms. Kelly Evans-Hullinger, MD. is part of The Prairie Doc® team of physicians and currently practices Internal Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM on SDPB and streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm. Prairie Doc Perspective Week of September 15th, 2024
“It’s Complicated” By Debra Johnston, MD My personal connection with adoption began nearly 30 years ago. As my mentor Dr Holm and I hurried to the hospital, he told me about the child he and his wife Joanie had recently adopted. Rick loved being a father, even more, it seems to me, than he loved being a doctor. He couldn’t quite believe that he got to parent this amazing little person, that he was blessed not just with Joanie and his sons, but with this precious girl who was now their daughter. His besotted delight so moved me that I knew I wanted to adopt, too. Over the next few years, I witnessed other families grow through adoption. I walked with women as they wrestled with unplanned pregnancies. I watched them grieve the children being raised by other mothers. I read blogs and books by adult adoptees who discussed their joys and their struggles. Nearly 10 years after that conversation with Rick, my husband and I, too, became part of an adoptive family. As an adoptive parent, I’ve often been told how “lucky” my children are. Of course this is flattering: every parent wants to believe they are doing that incredibly difficult job well. However, people aren’t usually complimenting us on our parenting. They are frequently responding to a feel good-narrative about the orphan who is now part of a family, with the expectation that we will all live happily every after. The reality of adoption is much messier. No child comes to adoption except through loss. At a minimum, that child has lost a parent: to poverty, addiction, mental illness, incarceration, death, or some combination of factors. Even infants experience distress on separation from their biological mothers. Many children have lost more than one parent or caregiver. Some children are in open adoptions and able to maintain a connection with their biologic families, although that connection may be tenuous. More are not. I have never understood how a culture obsessed with genealogy can simultaneously discount the importance to an adopted person of knowing their own genetic heritage. Around the time I graduated medical school, researchers published a groundbreaking study linking traumatic experiences in childhood to a myriad of significant health and social challenges in adulthood. Subsequent research has born this out. These traumas are common; estimates are that 2/3 of middle class people have experienced at least one. They include abuse and neglect, having a household member who experiences addiction, mental illness, or incarceration, witnessing domestic violence, and the loss of a parent. Additional research has demonstrated the impact of factors outside the home, such as bullying and community violence. The more of these a person experiences, the higher the likelihood that they will suffer, for example, heart disease, suicide, lung disease, mental illness, and even cancer in adulthood. Adoption, even adoption into a stable, loving, privileged family, doesn’t erase the trauma that preceded it. We can’t address those wounds if we won’t acknowledge them. Debra Johnston, MD. is part of The Prairie Doc® team of physicians and currently practices as a Family Medicine Doctor at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org , Facebook, Instagram, and Threads featuring On Call with the Prairie Doc® on SDPB, a medical Q&A show, 2 podcasts, and a Radio program on SDPB, providing health information based on science, built on trust. Prairie Doc Perspective Week of September 9th, 2024
“Backpacks and Back to School” By Jill Kruse, DO School is back in session so it is time for a little pop quiz. What is an item that almost every student carries? If you said backpack you are off to a great start. Do you know what it takes to be at the head of the class? Let’s find out if you are a star student or need to brush up a little on your backpack knowledge. Most students carry a backpack filled with their books at some point during their school day. Did you know a heavy back pack can cause neck, shoulder, or back pain. Those narrow straps can also compress on nerves in the shoulder leading to arm numbness, tingling, or weakness. Overweight backpacks can also change the center of balance making it easier to trip. Here is the first quiz question. A student’s backpack should not weigh more than what percentage of the student’s weight? A) 50%, B) 25%, or C) 15%? Answer: (C) The American Academy of Pediatrics recommends that a backpack weigh no more than 15% of a child’s weight. For example, a 60 pound child’s backpack should weigh no more than 9 pounds. Next question: What is the best way to wear a back pack? A) with one strap slung over one shoulder, B) with both straps used and using any additional chest or waist straps to help distribute the weight, C) dragging on the ground behind? The answer is, of course (B). Injuries are reduced when the backpack’s load is distributed across the body. Padded wide shoulder straps help distribute the weight evenly across the shoulders. Chest or waist clips can help take some of that load off the shoulders. There are some backpacks now that have wheels like suitcases. In that case, (C) rolling, not dragging, your backpack behind you may be a better option, but dragging a regular backpack is not a great idea if you want your backpack to last. Here is the last quiz question. Where should you put the heaviest items in your backpack? A) at the very top of the backpack, B) on one side of the backpack, or C) at the bottom and center of the backpack? The answer is (C) at the bottom and center of the backpack. The load should be closer to the wearer’s center of gravity at the small of the back. This helps decrease risk for tripping or falling from the wearer being off balance. How did you do? Before your student heads off to school, or you head off for a weekend hike, it is important for everyone to consider these wear and safety tips. Hopefully you do not find a forgotten sandwich from last year still stuck in the bottom. With this knowledge your students can be standing tall and proud at the head of the class. Have a great school year by staying safe and healthy out there. Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices as a hospitalist in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook, Instagram, and Threads featuring On Call with the Prairie Doc®, a medical Q&A show, 2 podcasts, and a Radio program, providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central and wherever podcast can be found. Prairie Doc Perspective Week of August 18th, 2024
Our Brain’s Happy Hormones By: Curstie Konold MPH, LCSW, QMHP Our brain releases chemicals into our body that impact functions in our body, such as our mood. There are four chemicals that commonly support “feeling good,” and they are also known as “happiness chemicals.” These four chemicals are dopamine, oxytocin, serotonin, and endorphins. Dopamine provides us with pleasure, motivation, and learning. Known as the reward chemical, dopamine may help us feel determined to accomplish our goals or meet our needs. Oxytocin is often known as the love hormone, and it creates a feeling of trust and security in maintaining relationships and bonding with others. Serotonin is often known as the mood stabilizer, and is the chemical that helps in regulating our moods. It often helps us with accepting ourselves, the people around us, and feeling significant within our relationships. Finally, endorphins are the natural “pain killer” in our body that releases a response to pain or stress to help in alleviating physical pain, anxiety, or depression. When we have a deficiency in each of these hormones, it can affect us in negative ways. Dopamine deficiencies can lead us to procrastinate, have low self-esteem, lack motivation, have low energy, feel fatigued, struggle to focus, and feel anxious or hopeless. Natural ways to increase dopamine levels in our body may include mediation, self-care, creating long term goals, creating a daily to-do list to maintain organization, celebrate small wins, regular exercise, and being creative through writing, music or art. Oxytocin deficiencies can leave us feeling lonely, stressed, lack motivation, have low energy or fatigue, feel disconnected, feel anxious, and experience insomnia. Some natural ways to increase oxytocin may include physical touch from a loved one, socializing, massage, acupuncture, listening to music, regular exercise, meditation, or giving others compliments. Serotonin deficiencies can lead to low self-esteem, feeling overly sensitive, feeling anxiety, having panic attacks, mood swings, feeling hopeless, feeling nervous about social events, experiencing obsessions, and experiencing insomnia. Natural ways to increase serotonin may be spending time outdoors, meditating, regular exercise, cold showers, sunlight and massage. Endorphin deficiencies can lead to anxiety, depression, mood swings, aches and pains, insomnia and impulsive behavior. Natural ways to increase endorphins may be laughing, creating music, art or writing, eating spicy foods, regular exercise, stretching, massage, and helping others. By working to become aware of deficiencies we may be experiencing within our body, we can implement natural skills to increase release of the happiness chemicals. This is one positive way we can take care of our mental health and increase our mood in a positive way. Curstie provides outpatient therapy for across the lifespan for adults, adolescents, and children starting at age 4. She utilizes a trauma-informed approach for people struggling with anxiety, depression, abuse, trauma, interpersonal issues, grief and social and emotional wellness. Her practice includes play therapy, solution-focused therapy, strengths-based therapy, and cognitive behavioral therapy and mindfulness strategies. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show providing health information based on science, built on trust for 22 Seasons, on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central. |
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